This guest post was written by Lauren Newman. Follow Lauren on instagram @gofeedyourself_
As a dietetic intern and HAES (Health at Every Size®) advocate, I’m in an usual position: I’ve spent the past several years learning from a weight-normative paradigm in classes, while simultaneously educating myself on a weight-inclusive one on my own time. Despite the rigor and highly respected education my program provides, this curriculum—like most—offers zero education on topics such as Intuitive Eating, Health at Every Size®, and weight stigma. I often felt as if I was learning in two separate worlds: none of my MNT (Medical Nutrition Therapy) classes addressed these important issues, and none of my mentors in the HAES community were practicing in a clinical setting. For a long time, I incorrectly assumed that these two worlds didn’t fit together. I knew of no one who was doing it and heard countless stories of RDs ditching their clinical jobs once they discovered IE (Intuitive Eating) and HAES. This was disappointing because I genuinely find Medical Nutrition Therapy and critical care exciting!
As I’ve worked my way through my clinical dietetic internship placements, I’ve begun to explore this intersection on a deeper level. First of all, I think it’s important to acknowledge a few things: obviously a 15-minute consult with a patient in a critically ill state is not the time to whip out your Intuitive Eating (IE) workbook and challenge them to change their entire mentality around food and nutrition. Deep dives into the IE principles are much more appropriate in an outpatient setting with a client who is willing and ready to do that work. Additionally, when someone is in the hospital, they are usually pretty disconnected from their body. These patients don’t have the privilege of connecting with their intuition (because, yes, that is a privilege!). However, this doesn’t mean that you as a provider can’t practice from a HAES/IE approach when working with these patients!
I think it helps to start by identifying the Intuitive Eating principles that can still be applied to an individual disconnected from their body:
- Reject the diet mentality: It’s totally possible to express to your patient that you’re not concerned with their weight without having to explain the intricacies of a non-diet approach! Focus on your patient’s overall health and how they’re feeling, and understand weight as a symptom of other things going on—not the cause!
- Challenge the food police: I’m the first to admit that it’s hard to not feel like the food police when your job is to educate a patient on their new carb controlled, low fat, low cholesterol, renal diet. I find it helps to take the time to explain physiologically why these changes are recommended. When you think about it, they actually stem from what this person’s body would intuitively be telling them if they were able to listen. For example, we don’t just randomly count carbs for diabetes. We understand that if a diabetic ate a lot of carbs at once (or not enough with their insulin) they wouldn’t feel great! Or if someone fluid restricted went overboard, their edema would worsen. Over time, if these patients could tune into their intuition (which, we know isn’t usually possible at the moment), they would likely be making food choices similar to these recommended diet patterns because that’s what would make them feel best. It helps me as a provider to understand MNT recommendations from this perspective and reframe my role as a liaison between my patient and their body, rather than as the food police.
- Satisfaction factor: Rather than just telling your patient what they can and can’t eat, take the extra minute to get to know them and their eating habits. Brainstorm ways to make their favorite foods work for them so they will continue to feel satisfied, not restricted. If a specific food they enjoy is completely off limits, discuss other flavors, textures, temperatures, seasonings, etc. that might work to create a similarly satisfying experience for your patient!
- Honor feelings without using food: Emotional eating is a totally normal response to a stressful and/or traumatic situation—which is often what our patients are experiencing. Obviously it’s important to stay without our scope and consult additional healthcare providers where necessary, but it never hurts to acknowledge and validate that what a patient is experiencing is hard! So many health care practitioners become desensitized to these emotional struggles, and I’ve noticed that many patients don’t get enough emotional validation.
- Respect your body and honor your health: As previously stated, this is not the setting to deep dive into body image or size acceptance work. However, I think it’s important to remind patients (and remind ourselves!!) that often they can’t control their health. Many of these conditions are genetic, chronic, age-related, degenerative, or just straight up accidents! It doesn’t help their health to beat themselves up over being ill. We also cannot control how quickly a patient will heal. This can be frustrating, but respecting our patients’ bodies’ abilities and limitations is a crucial part of honoring their health.
There are also several steps you can take in interactions with other healthcare providers to care for your patients from a HAES approach! I’ve seen several resources circulating in the community discussing weight-neutral PES statements (Nutrition Diagnostic Statement). If you’re struggling to document care of a patient from a Health at Every Size® approach, these might be helpful! I also think it’s important to advocate for the fact that health (and illness) can exist in all body types and at all sizes. Check your own bias on that and stand up for your patient when you hear other RDs, MDs, RNs, etc. indicate otherwise!
I’m far from an expert in this area, but I figure I can’t be the only one struggling with this intersection! These are just a few things I’ve done over the past few months to keep myself grounded in my HAES beliefs while working with critically ill patients and interacting with healthcare professionals still deeply rooted in a weight-normative approach to care.